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Cited by 151Maternal and fetal healthcarePregnancy and preeclampsia studiesReproductive System and Pregnancy

Diagnosis of placental abruption: relationship between clinical and histopathological findings

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Elsasser, Denise A., Ananth, Cande V., Prasad, Vinay, Vintzileos, Anthony M.·2010·European Journal of Obstetrics & Gynecology and Reproductive Biology
DOI 10.1016/j.ejogrb.2009.10.005PMC PMC2814948
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Abstract

Objective We evaluated the extent to which histologic lesions bearing a diagnosis of abruption conform to a diagnosis based on established clinical criteria. We further examined the profile of chronic and acute histologic lesions associated with clinical abruption.Methods Data from the New Jersey-Placental Abruption Study - a multi-center, case-control study - were utilized to compare the clinical and histologic criteria for abruption. The study was based on 162 women with clinically diagnosed abruption and 173 controls. We examined the concordance between clinical indicators for abruption with those of a histopathological diagnosis. The clinical criteria for a diagnosis of abruption included (i) evidence of retroplacental clot(s); (ii) abruption diagnosed on prenatal ultrasound; or (iii) vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity. The pathological criteria for abruption diagnosis included hematoma, fibrin deposition, compressed villi, and hemosiderin-laden histiocytes in cases with older hematomas. Acute lesions included chorioamnionitis, funisitis, acute deciduitis, meconium stained membranes, villous stromal hemorrhage, and villous edema. Chronic lesions included chronic deciduitis, decidual necrosis, decidual vasculopathy, placental infarctions, villous mal-development (delayed or accelerated maturation), hemosiderin deposition, intervillous thrombus, and chronic villitis.Results Of clinically diagnosed cases, the sensitivity and specificity for a histologic confirmation of abruption were 30.2% and 100%, respectively. Presence of retroplacental clots remained the single most common finding (77.1%) among clinically diagnosed cases. Among the acute lesions, chorioamnionitis and funisitis were associated with abruption. The only chronic histologic lesion associated with abruption was placental infarctions.Conclusions The concordance between clinical and pathologic criteria for abruption diagnosis is poor. The criteria for diagnosing a clinical abruption should include sonographic visualization of abruption, evidence of retroplacental clots, or vaginal bleeding accompanied by nonreassuring fetal status or uterine hypertonicity.

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  • Ultrasound may identify findings concerning for abruption, especially when abnormal blood collections adjacent to and within the placenta are large.

    “Ultrasound may identify findings concerning for abruption, especially when abnormal blood collections adjacent to and within the placenta are large (FIGURE 3–5) (50).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [50]

    The Discussion identifies ultrasound diagnosis as a clinical indicator of placental abruption, while noting that it was a weak marker in this study. The paper does not say that ultrasound is especially useful when blood collections are large, or describe sonographic collections both adjacent to and within the placenta. The described retroplacental hematomas are findings from placental examination, not ultrasound. (LLM, conf=0.86)

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  • The amount of vaginal bleeding does not correlate with clinical sequelae.

    “The amount of vaginal bleeding, which may be difficult to quantify due to concealed bleeding, does not correlate with clinical sequelae (50).”

    From Placental abruption at near-term and term gestations: Pathophysiology, epidemiology, diagnosis, and management (2023) · cites this paper as [50]

    The Methods section (page unavailable) categorizes when vaginal bleeding occurred, and the Results and Discussion describe bleeding as a diagnostic indicator. None of the passages found assesses whether the amount of vaginal bleeding correlates with clinical sequelae or says that concealed bleeding makes that amount difficult to quantify. Searches for bleeding volume, severity, concealed bleeding, and sequelae did not locate such a finding. (LLM, conf=0.76)

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Authors
Elsasser, D. A., Ananth, C. V., Prasad, V., & Vintzileos, A. M.
Affiliations
  • Nationwide Children's Hospital (US)
  • Winthrop-University Hospital (US)
ORCID
Venue
European Journal of Obstetrics & Gynecology and Reproductive Biology
Publisher
Elsevier BV
Published
2010-02
Volume
148
Issue
2
Pages
125-130
ISSN
  • 0028-2243 (ISSN-L)
  • 0301-2115
DOI
10.1016/j.ejogrb.2009.10.005
PMC
PMC2814948
OpenAlex
W1966530833
Cited by
151
References
38
Citations by year
2026: 4 · 2025: 11 · 2024: 8 · 2023: 11 · 2022: 15 · 2021: 14 · 2020: 8 · 2019: 12 · 2018: 9 · 2017: 8 · 2016: 9 · 2015: 10 · 2014: 6 · 2013: 9 · 2012: 7
FWCI
4.75
Type
journal article
Language
en
Open access
Licence
Locations
  • European Journal of Obstetrics & Gynecology and Reproductive Biology (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institutes of Health
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD038902)
Topics
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Maternal and fetal healthcare
  • Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy and preeclampsia studies
  • Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
Keywords
placental abruption, diagnosis, histopathological diagnosis, diagnostic agreement, chorioamnionitis, funisitis, placental infarction, decidual vasculopathy, chronic villitis, sensitivity and specificity
MeSH terms
Abruptio Placentae, Adult, Female, Humans, Placenta, Pregnancy, Case-Control Studies, Young Adult

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